Optimization of Electronic Health Record Usability

Discussion Tips

In 2009, the Health Information Technology for Economic and Clinical Health Act (HITECH) became law. HITECH provided Federal financial incentives to increase the adoption of electronic health records (EHRs). Now, 15 years later, most outpatient physician offices and hospitals use EHRs. However, physicians generally rate the usability of electronic health record programs as low. In this issue of Annals, Franks et al describe a quality improvement project designed to optimize the use of a newly introduced EHR at the department level of an academic center that serves primarily rural patients.

Discussion Questions

• What questions are asked by this study and why does it matter?

• How does this study advance beyond previous research and clinical practice on this topic?

• What was the intervention? Who participated in the assigned groups?

• How strong is the study design for answering the question?

• To what extent can the findings in Figure 1 be explained by world, geographic region, and intradepartmental events? If you could eliminate constraints to data availability, how would you strengthen the study design?

• The study authors chose charges, payments, and visits as process measures to measure EHR optimization success. What are some other ways to measure the success of EHRs, in general, and EHR optimization, specifically?

• What are the advantages and disadvantages of the way the authors accounted for and quantified optimizations?

• The authors report the proportion of each optimization type by each office process in Table 2. What do these proportions imply about each office process?

• What are the main study findings?

• How comparable is the study sample to similar patients in your practice or region? What is your judgment about the transportability of the findings since this quality improvement initiative was performed at an educationally focused department of family medicine?

• What contextual factors are important for interpreting the findings? Do you think this project would result in similar outcomes if the EHR had been in place for ~5 years?

• How might this study change your practice? Policy? Education? Research?

• Who are the constituencies for the findings, and how might they be engaged in interpreting or using the findings?

• What are the next steps in interpreting or applying the findings?

• What researchable questions remain?